Head and Neck surgery
Head and neck surgery includes diagnosis and treatment of benign and malignant conditions in the head and neck region. This includes investigation for neck lumps, voice change, swallowing difficulty and pain on swallowing, disease of the thyroid and parathyroid gland and conditions of salivary gland. It also involves investigation and treatment of conditions affecting the mouth and facial skin.
Diseases of the throat and neck
- Tonsillitis and pharyngitis
- Swallowing difficulties
- Sensation of lump in the throat
- Hoarse voice and other voice related problems
- Lump and swelling in the neck
- Diagnosis of cancer
The spectrum of head & neck surgery includes diagnosis and treatment of benign conditions within the head and neck and also diagnosis and treatment of head and neck cancer. Common conditions include persistent sore throat, fluctuating voice, sensation of lump in throat etc. These conditions are rarely serious and can be managed successfully but need thorough investigations.
Diseases of the salivary glands
Salivary gland diseases present usually as a swelling within the gland which can increase in size after eating or drinking. The swelling can cause discomfort and pain if it is infected. Very occasionally salivary glands can also develop a persistent lump which could be benign and rarely malignant.
Salivary gland pathology can be managed successfully by either conservative treatment and occasionally needing surgery to remove the affected gland.
Change in voice is very common and is usually following an episode of laryngitis. This condition can improve spontaneously and the voice can return to normal. Voice change which is persistent over 6 week’s needs urgent evaluation as very occasionally this could be due to a more sinister cause.
Voice problems can be managed with voice therapy, but at times can also need microlaryngeal surgery to remove pathology from the vocal cords. This could be due to benign conditions like vocal cord polyps or cysts, but occasionally more sinister pathology.
Management of head and neck cancer
Head and neck cancer is a diverse group of cancers affecting different parts of the throat and presenting in different ways. Most cancers, if diagnosed at early stages, can be treated successfully with very good outcome.
Head and neck cancer is fortunately not very common and therefore sometimes early diagnosis can be difficult. Most head and neck cancers would present with symptoms which are persistent and could include symptoms like persistent hoarseness of voice, swallowing difficulties, persistent pain on swallowing and palpable swelling in the neck. All of these above conditions can also be caused by other common conditions which are not related to cancer. Diagnosis of cancer will include a thorough examination including a flexible endoscopic examination of the nose and throat. This is usually performed under local anaesthetic nasal spray. It causes minimal discomfort and takes a very short time.
If there is an obvious swelling in the neck, the patient may also need an ultrasound scan or an MRI/CT scan. A biopsy of the lesion may also have to be performed either under a local anaesthetic, but more commonly under a general anaesthetic. Once diagnosis of cancer has been confirmed, the case will be discussed at the regional head and neck multi-disciplinary meeting along with other clinicians to confirm the staging and the best way to treat the cancer.
Treatment for head and neck cancer includes either surgery by itself or a combination of surgery, radiotherapy (IMRT) and chemotherapy. The choice of treatment depends on the site and stage of cancer and also individual patient factors. The decision for treatment is made at a multi-disciplinary team meeting which includes various specialists. Once treatment is complete, the patient is followed up at regular intervals for up to 5 years, but very occasionally, the follow up can be longer.
Disease of the thyroid and parathyroid
Thyroid and parathyroid diseases are relatively common. Most thyroid-related problems present as swelling in the neck, but the thyroid function test may be entirely normal and the patient may not have any other symptoms. The vast majority of thyroid swellings are benign and may not need any treatment once diagnosis has been made. Some thyroid swellings may be due to thyroid cancer which is diagnosed with a needle biopsy performed under ultrasound guidance. Thyroid swellings which are benign may not need surgical removal unless they cause symptoms or are cosmetically unsightly. The swellings which are diagnosed as thyroid cancer will need definitive treatment, usually in the form of removal of the thyroid gland either half or total followed by iodine treatment in some cases. The success and survival of patients with early diagnosis of thyroid cancer is extremely good. Following completion of treatment these patients will need long-term follow up and blood tests at regular intervals.